Healthcare Provider Details

I. General information

NPI: 1619268174
Provider Name (Legal Business Name): STEVEN PETI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SEAVIEW AVE
STATEN ISLAND NY
10305-3436
US

IV. Provider business mailing address

255 FRONT ST
BINGHAMTON NY
13905-2427
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-1008
  • Fax: 718-226-1039
Mailing address:
  • Phone: 607-778-3938
  • Fax: 607-778-2873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number273649
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: